NMOSD and MOGAD in Latin America: A consensus-informed regional perspective

Neuromyelitis optica spectrum disorder (NMOSD) and myelin oligodendrocyte glycoprotein antibody-associated disease (MOGAD) are rare autoimmune disorders of the central nervous system whose diagnosis increasingly relies on highly sensitive antibody assays and timely access to targeted therapies. Despite major advances in the diagnosis and management of these disorders worldwide, substantial challenges continue to compromise patient care across Latin America (LATAM).

This consensus-informed regional perspective was developed as an initiative of the European Charcot Foundation (ECF) Young Investigators/Fellows, following discussions held during the "2025 Update on NMOSD & MOGAD" ECF Meeting in São Paulo/Brazil, and in collaboration with international and Latin American experts. This manuscript synthesizes current evidence on the epidemiology, clinical characteristics, diagnosis, treatment, and healthcare challenges of NMOSD and MOGAD in LATAM, together with a consensus-informed assessment of regional priorities and unmet needs.

Recent epidemiological studies have improved understanding of the burden of NMOSD and MOGAD across LATAM. Nevertheless, delayed diagnosis, disease misclassification, unequal access to specialized neuroimmunology services, and considerable variability in antibody testing methodologies remain major barriers to optimal patient management. Although commercial fixed cell-based assays (fixed-CBAs) have become increasingly available throughout the region, access to gold-standard live cell-based assays (live-CBAs) remains restricted to a limited number of specialized centers, potentially compromising diagnostic accuracy in some settings. Likewise, despite growing evidence supporting early initiation of highly effective therapies, particularly for AQP4-IgG-positive NMOSD, access to these treatments is limited in many locations, resulting in continued reliance on conventional immunosuppressive agents.

Based on the available evidence and expert consensus, this regional perspective identifies two strategic priorities for advancing the diagnosis and management of NMOSD and MOGAD in LATAM: (I) expanding access to locally performed live-CBA and (II) ensuring equitable access to highly effective emerging therapies. Together, these priorities have the potential to harmonize clinical practice and reduce healthcare disparities across countries. They may also foster regional neuroimmunology collaborations, facilitating the generation of reliable region-specific real-world evidence, ultimately benefiting patients with NMOSD and MOGAD throughout LATAM.